Archive for November, 2012

Nurses can help improve vaccination rates

Friday, November 30th, 2012 (last updated)

Nurses can help improve vaccination rates

More elderly and at-risk adults get their flu and pneumonia vaccinations when the shots are coordinated and given by nurses instead of doctors, a new analysis suggests.

Researchers linked the changeover to a 44-percent increase in patients’ chances of getting a flu shot and a more than doubling of their likelihood of getting vaccinated against pneumonia.

Jeffrey Johnson, who worked on the study, said there’s been a recent effort to get public health nurses and pharmacists involved in giving vaccines – although policies vary by state in the U.S. He said shifting responsibility to non-doctors might be especially helpful for people with chronic diseases.

“The family physician has all of the responsibility to look after the patient, and so somebody with diabetes, for example, comes in and their first concern is their blood sugar and their blood pressure and pretty soon, the time for the visit is up,” Johnson, from the University of Alberta in Edmonton, Canada, told Reuters Health.

“But for a nurse in the primary care setting, (vaccinations and other preventive care) might be the first thing they’re responsible for,” he added.

“The evidence, we think, clearly shows that shifting the responsibility and the ability to vaccinate to non-physician personnel… That works.”

The new analysis is part of research Johnson and his colleagues have been conducting on vaccinations in the elderly and people with chronic diseases – looking at both how effective they are, and how to encourage more people to get them.

His research team analyzed 77 studies of the success of financial incentives, patient outreach and other strategies to improve vaccination rates for flu and pneumonia, in particular.

The U.S. Centers for Disease Control and Prevention recommends all adults and children get the flu shot every year. Adults older than 65 and those with certain chronic conditions are supposed to get the so-called pneumococcal vaccine, as are young kids.

The researchers found that changing who performs vaccinations – especially putting the job in the hands of trained nurses – was one of the most successful vaccination-promoting strategies, along with calls and texts to patients reminding them about the shots.

But even with the team-change strategy, typically less than half of all eligible people got their vaccines, according to findings published in the Annals of Family Medicine.

“In the end, the effectiveness of these things is still pretty modest,” Johnson said.

“We need to think of ways to amplify the effect. An obvious one would be to combine the approaches.” That could mean making nurses responsible for giving the vaccines and also for reaching out to patients by phone to encourage them to come into the office, he said.

Improve Influenza and Pneumococcal Vaccination RatesClick here

Reuters & Annals of Family Medicine

Meningitis A vaccine breaks barrier: first to gain approval to travel outside cold chain

Thursday, November 29th, 2012 (last updated)

Minister of Health Onyebuchi Chukwu says Nigeria is seeking the support of Global Alliance Vaccines Immunisation (GAVI) to resume the production of yellow fever vaccine.

Chukwu disclosed this in an interview on the outcome of the just concluded World Health Organisation African Regional Meeting on Polio held in Luanda, Angola.

He said that the country had also solicited support toward the introduction of new rotavirus and human papillomavirus vaccines.

The minister said that the support became necessary given the need to strengthen routine immunisation in the country.

Rotavirus vaccines protect children from rotaviruses, which are the leading causes of severe diarrhea among infants and young children, while human papillomavirus vaccine is used for the treatment of cervical cancer.

“What we discussed was to review the state of immunisation in Nigeria; the support that GAVI is giving to Nigeria; the possibility of introducing some additional new vaccines such as the router virus and the human papillomavirus vaccine for cancer of the cervix; and also the need to support local industries; we have at least one company that is WHO-prequalified as manufacturing syringes.

“GAVI says that there is room for them to be supported in terms of been patronised for their products. We also looked at the issue of Nigeria resuming the production of yellow fever vaccines; and again GAVI will be visiting Nigeria next one week or so;  we are going to hold discussions on whether they are going to give us some support to move towards being able to produce the yellow fever vaccine in Nigeria.’’

Chukwu expressed concern over the refusal by some Nigerians to accept the polio vaccine, but assured that government would strive towards the total elimination of polio.

He said WHO and other development partners were working toward reviewing the polio situation in Nigeria, Democratic Republic of Congo, Angola and the Republic of Chad.

“Nigeria made its presentation, re-emphasising the new emergency plan for polio eradication in the country, the result so far this year shows that there is indeed a progressive downward trend in the number of cases that are being reported.

“In Oct., two cases were reported and that brought the total for this year to 101 cases of wild polio virus transmission; but since Nov. we have not had any single report, which underscores the fact that with improved surveillance, with the new plan, we progressively reached the peak in July.

“But now that we are enjoying the benefits of that work, the numbers of cases is dropping and we expect that it is going to drop to zero.

“And of course the target as Mr President declared after meeting with the endemic states, endemic local governments and stakeholders in Abuja, is that certainly Nigeria is looking forward to 2013 as when we should achieve zero transmission of polio.’’

According to the minister, delegates at the meeting discussed the required funding mechanism, gaps as well as what was on ground with regards to vaccinators and how well such vaccinators were being supervised and whether or not their welfare needed to be improved.

Chukwu said that emphasis was made on the need to strengthen routine immunisation, stressing that the Midwives Services Scheme (MSS) was one of Nigeria’s approach to boosting routine immunisation.

Chukwu appealed to international development partners to support African countries financially, adding that the issue of not receiving supplies of vaccines even after payment had been made, remained a very critical factor.


Whooping cough spreads through New Mexico

Thursday, November 29th, 2012 (last updated)

Experts blame whooping cough outbreak on parents who don’t get their kids immunized.

Kob TV4

Does the success of a school-based HPV vaccine programme depend on teachers’ knowledge and religion?

Wednesday, November 28th, 2012 (last updated)

Organized introduction of prophylactic human papillomavirus (HPV) vaccination can reduce the burden of cervical cancer in developing countries. One of the most effective ways is through a national school-based program. Information on teachers is therefore important since this group may have a disproportionate influence in the success of any implementation.

Objective: To assess teachers’ knowledge and perception of HPV, cervical cancer and HPV vaccine prior to commencing a school-based HPV vaccination program in a multiethnic, predominantly Muslim country. Factors associated with acceptability of the vaccine were identified.

Method: A bilingual questionnaire was applied to 1,500 secondary school teachers from 20 urban schools in Malaysia. Data collected were analyzed using SPSS version 17. Results: 1,166 questionnaires were returned. From this group, 46.1% had never heard of HPV while 50.9% had never had a pap smear. However, 73.8% have heard of the HPV vaccine with 75% agreeing to have it. 96% considered themselves religious with 79.8% agreeing to have the vaccine.

Conclusions: A national school-based HPV immunization program can be implemented effectively in a multiethnic, cultural and religious country despite limited knowledge of HPV-related pathology among teachers. In addition, the perception that religion has a negative influence on such a program is unwarranted.

Asian Pacific Organization for Cancer Prevention

Human papillomavirus vaccine Cervarix: safety review shows balance of risks and benefits remains clearly positive

Tuesday, November 27th, 2012 (last updated)

Since September 2008 the human papillomavirus (HPV) vaccine Cervarix has been used extensively in the UK routine HPV immunisation programme to prevent cervical cancer. We have previously reported on the safety of the vaccine following the first and second  year of use.

While its safety evaluation has been continuous, we conducted a further safety review of the totality of the UK experience with Cervarix up to the end of July 2012. No new safety concerns were identified and the number and nature of adverse reaction (ADR) reports received was as expected after administration of at least 6 million doses of the vaccine in the UK.

Before Cervarix was first used the MHRA anticipated that a range of medical conditions naturally prevalent in the adolescent female population would occur in temporal association with vaccination and might be reported as suspect side effects. Statistical methods were therefore put in place to rapidly assess whether such reports were consistent with chance, or whether they could be new side effects of the vaccine.

One such condition was chronic fatigue syndrome (CFS) – the level of reporting for which was found to be well within the expected background incidence rate. An ecological study and a self-controlled case series study using the Clinical Practice Research Datalink (CPRD) also did not find an increased risk of fatigue syndromes with Cervarix.

Overall, the safety experience with Cervarix up to the end of July 2012 supports the previous conclusion that the balance of benefits and risks of Cervarix remains clearly positive.


One of my favorite charts on the power of vaccines

Tuesday, November 27th, 2012 (last updated)

diarrhea related deaths

I’m posting this because I found the graphic in a file folder on my computer and didn’t want to lose it. It’s originally from my profile of Bill Gates from last year’s Forbes Power List issue. The data (and the original version of the graph) come from the New England Journal of Medicine. This is a graph of what happened when the vaccine against rotavirus, a major cause of infant diarrhea, was introduced in Mexico.

See that series of mountains? Those are the big peaks in deaths that were caused each time rotavirus season came around. After the vaccine was introduced (one rotavirus vaccine is made by Merck; there’s also a GlaxoSmithKline vaccine), those mountains just get sheared off. Those are kids who are not dying as a result of a vaccine a short period of time after its use. To me, it’s a very dramatic graph and evidence of the power that pharmaceutical products can have to improve people’s lives in the right circumstances.


Meningitis A vaccine breaks barrier: first to gain approval to travel outside cold chain

Friday, November 23rd, 2012 (last updated)

MenAfriVac, a meningitis A vaccine, recently received approval to be kept in a controlled temperature chain at temperatures of up to 40 degrees Celsius for up to four days.

“The potential for some vaccines to remain safely outside the cold chain for short periods of time has been widely known for over 20 years,” Michel Zaffran, the director of Optimize, a PATH-World Health Organization collaboration, said. “But this is the first time that a vaccine intended for use in Africa has been tested and submitted to regulatory review and approved for this type of use. And we expect this announcement to build momentum for applying the CTC concept to other vaccines and initiatives, allowing us to save more lives in low-income countries.”

A team of experts consisting of experts from WHO, PATH, Health Canada and the Serum Institute of India, Ltd., analyzed the heat stability of MenAfriVac prior to approval for travel outside the cold chain.

“Vaccines save and improve lives wherever they are used, but reaching the millions of children in last mile communities like those in rural Africa continues to challenge us,” Orin Levine, the director of vaccine delivery at the Bill & Melinda Gates Foundation, said. “Today’s announcement marks a new milestone because it allows us to extend the delivery of the MenAfriVac vaccine from the traditional cold chain and reach more people across Africa, safely and efficiently.”

From Dakar to Addis Ababa, a region known as the meningitis belt, as many as 450 million people are at risk from meningitis. Meningitis A epidemics occur every seven to 14 years and can be devastating to young adults and children.

“The new flexibility in delivering this vaccine represents a huge step forward,” Zaffran said. “It took the work of a dedicated team to break through political, operational, and regulatory barriers to get this vaccine re-labeled.”

Vaccine News

“The Amazing Meeting” about the anti-vax movement

Friday, November 23rd, 2012 (last updated)

The Amaz!ng Meeting 7 Panel discussion about the Anti Vax movement. The benefits of vaccination far outweigh the supposed risks. The panel talk gave many examples of how vaccines have helped eradicate diseases that caused millions of deaths around the world.

Steve Novella an American clinical neurologist, assistant professor and Director of General Neurology at Yale University School of Medicine. Novella is best known for his involvement in the skeptical movement.

James Randi Foundation

What would happen if we stopped measles vaccinations?

Thursday, November 22nd, 2012 (last updated)

In the U.S., vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines. Vaccine-preventable diseases have many social and economic costs: sick children miss school and can cause parents to lose time from work. These diseases also result in doctor’s visits, hospitalizations, and even premature deaths.

Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963.

In the U.S., up to 20 percent of persons with measles are hospitalized. Seventeen percent of measles cases have had one or more complications, such as ear infections, pneumonia, or diarrhea. Pneumonia is present in about six percent of cases and accounts for most of the measles deaths. Although less common, some persons with measles develop encephalitis (swelling of the lining of the brain), resulting in brain damage.

As many as three of every 1,000 persons with measles will die in the U.S. In the developing world, the rate is much higher, with death occurring in about one of every 100 persons with measles.

Measles is one of the most infectious diseases in the world and is frequently imported into the U.S. In the period 1997-2000, most cases were associated with international visitors or U.S. residents who were exposed to the measles virus while traveling abroad. More than 90 percent of people who are not immune will get measles if they are exposed to the virus.

According to the World Health Organization (WHO), nearly 900,000 measles-related deaths occurred among persons in developing countries in 1999. In populations that are not immune to measles, measles spreads rapidly. If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected.

In the U.S., widespread use of measles vaccine has led to a greater than 99 percent reduction in measles compared with the pre-vaccine era. If we stopped immunization, measles would increase to pre-vaccine levels.


Don’t be the one to spread the flu

Wednesday, November 21st, 2012 (last updated)